If we can ever be sure of one thing in EMS, it’s change. Be it scope of practice, changing patient conditions or shifting payer mixes, things are changing.
Mobile integrated healthcare is an overarching term that captures the concept of a new type of EMS delivery system. In most cases, MIH is a more cost-effective and more efficient method of providing appropriate care to the ever-growing population of 911 callers who have a medical issue that should be dealt with but doesn’t constitute an emergency as well as callers who don’t need a quick emergency response.
An MIH program may use EMTs, paramedics, nurse practitioners, physician assistants or a combination of these types of professionals.
MIH is not designed to replace the existing EMS system for 911, which will continue to meet patients’ needs that are serious and where a quick response is vital. Rather, MIH is a delivery system for the non-emergent caller that will work side by side with the existing EMS delivery system.
Today, MIH is spreading across the United States, and the EMS profession is paying attention and in many places engaging. However, make no mistake, this handbook is not a mandate that MIH must be implemented in all EMS agencies. Rather, it contains guidance to assess whether MIH is right for individual EMS providers, how to implement an MIH program and how to make it financially sustainable.
The National Association of Emergency Medical Technicians (NAEMT) highlighted more than 135 developed and functioning MIH programs across the United States in their report published in May 2015 (Mobile Integrated Healthcare and Community Paramedicine; NAEMT, 2015). The National Association of State EMS Officials did a study that found that 29 states, or 60%, had between one and 25 agencies offering MIH-type services (Community Paramedicine/Mobile Integrated Health Committee; National Association of State EMS Officials, 2014).
MIH is not a fluke but a trend designed to solve the inefficiencies inherent in the ways traditional EMS is delivered.
A major roadblock to the wider spread implementation of MIH is the lack of reimbursement in most systems. October saw the announcement that Anthem BlueCross BlueShield will begin to pay for treatment without transport for patients in states where it offers commercial coverage.
This new policy marks a vital step toward the goal of sustaining community paramedicine and MIH programs that have sometimes struggled to find ongoing financial footing.
The reimbursement will be offered for HCPCS A0998-coded 9-1-1 responses in:
- California
- Colorado
- Connecticut
- Georgia
- Indiana
- Kentucky
- Maine
- Missouri
- Nevada
- New Hampshire
- New York
- Ohio
- Virginia
- Wisconsin
The company hopes to include its Medicare and Medicaid plans as well, though there are varying state requirements to navigate first. Due to those differences, not all 14 states will begin January 1, though most will. This may well be a major tipping point for MIH!
History proves that when change is needed, America’s fire and emergency services rise to the occasion. For example, when the entire service-delivery model was turned on its head and the singularly focused fire-suppression industry adopted paramedicine and EMS, the fire industry responded and implemented changes that continue to mark our systems today.
For those who witnessed this change, it was a groundbreaking moment in our profession. It didn’t come easy and there were many detractors.
MIH will be such a moment in our profession, also ushered in with both praise and criticism. The authors of this handbook hope that through reading it, innovative and courageous chiefs will gain support and guidance for change as America’s fire and emergency service takes the lead.